Applications for Insurance
For your convenience, we have provided the following applications and questionnaires in .pdf, .doc, and .xls format.
1. Follow the link to the appropriate application.
2. Fill out the PDF fillable form, word doc, or excel file on your computer.
3. Save the file.
4. Send an email to your Clarke & Sampson agent with the attached file.
Helpful Hint: Download the applications by "right clicking" and download the linked file to avoid internet browser errors.
Some fIles may not appear to be electronically fillable. Simply click on the space you would like to fill and a text bar will appear.
Bonds
General Surety Form- Travelers
Commercial Surety Application- The Hartford
Probate/Court Bond Application- Travelers
Commercial
Fiduciary Liability New Business & Renewal App- Travelers
WRAP App- Travelers
Exporters Package Application- Chubb
Multimedia Liability App- Chubb
Private Company Forefront App- Chubb
Liquor Liability Application- US Liability
Disability Benefits Law Application- The Hartford
Special Programs
Political Campaign Insurance Application
Restaurant Insurance Questionnaire
Non-Profit Forefront Application- Chubb
Special Events
Amateur Sport Event Insurance Application
Non Sporting Event Insurance Application
Liquor Liability Special Event Application
Life & Health
Miscellaneous
WC Waiver of Subrogation Request ERM-14 Form
Commercial- ESIGN Delivery Consent
Personal- ESIGN Delivery Consent